Periodontal Disease

Types of Dental Cleaning

The purpose of dental cleaning is to remove the food debris on the tooth.  However, there are situation in which the teeth may need a deeper cleaning and many patients might not understand the difference between the regular dental cleaning and this “deeper” dental cleaning.  So let me explain here types of dental cleaning.

There are many levels of dental cleaning depending on the clinical findings which indicates the underlying dental disease process.  The clinical findings can be multitude of measurements such as depth measurement of the periodontal pockets around the tooth, the amount and location of the dental calculus and the radiographic finding of bone loss.

The followings are different level of dental disease process and types of cleaning needed to help control the disease progression:

–  Healthy Gum within pocket 0-3 mm –  This is the healthy gum with periodontal disease. The pocket measurement is from 0 to 3 mm.  Absence or almost no bleeding upon probing.  Minimal plaque and no bone loss.  The patient would need regular basic dental cleaning.

–  Mild to Moderate Periodontal Disease with pocket from 3-4 mm – This is a person with mild to moderate periodontal disease process.  The clinical finding shows pocket measurement from 3-5mm.  There is usually accompanied by bleeding upon probing.  Plaque and calculus can be detected below the gum line.  Radiograph can show calculus and some bone loss.  The patient would need a “deeper” cleaning called the Scaling and Root Planing procedure.  It is indicated for complete removal the disease-causing calculus from within the gum pockets on the teeth.  This procedure is usually performed at the general dentist’s office.

–  Severe Periodontal Disease with pockets greater than 5mm.  This indicates a more severe periodontal disease status and it requires more extensive treatment and surgery.  Patient might be referred to the Periodontist for periodontal surgery and special antibiotics to help control the disease progress.

So “deeper” cleaning is really just a lay-man term for a special treatment to treat the periodontal disease.  It should be better understood as periodontal treatment.  I often would tell patient that this is not just a cleaning but rather to cure a specific dental disease.


Written by Daniel Tee, DDS, MS

Genral Dental Office in Tempe AZ — White Tooth-Colored Fillings, Porcelain Crowns, Veneers, Inlays, Onlays

Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona. Practicing General Dentist

Severe Periodontal Disease Causes Bone Loss and Tooth Loss

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Periodontal disease is a silent disease.  In the beginning and even in the moderate stage of the disease process, a person will often feel no symptoms.  Perhaps their gum will bleed when they brush.  If left untreated, the periodontal disease can cause serious dental problems such as persistent abscess in the gum and tooth loss.

The periodontal disease can be a slow disease progress.  However, often people will not notice it until at a much later stage.  The bacteria in periodontal disease causes erosion of the bone around the teeth.  Slowly over time, the teeth will become mobile and due to lack of the support from the surrounding bone, teeth may collapse and then tooth loss.

The following is the xray radiograph of a person having severe periodontal disease.

Severe Periodontal Bone Loss Dental

Severe Periodontal Disease causes severe bone loss

The radiograph image shows multiple teeth having black shadow around the root area.  The shadow can either be persistent infection due to bacteria and this leads to bone loss.  Clinically, multiple teeth have severe mobility because there is not enough bone to anchor each tooth.  The teeth appears to be very long because there is recession to the bone and the gum.  Some upper teeth has fallen down into the empty spaces.  The prognosis of his teeth are poor and eventually he would have to have all of this teeth extracted and get full dentures.

One way to help avoid periodontal disease is to have periodic dental checkup and cleaning.  Dentist will check if you have any periodontal disease and recommends periodontal treatment if needed.  Periodontal treatment is an on-going process and patient needs to work with the doctor to follow the oral hygiene instructions and commit to periodic recall treatment schedules.


Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Dental Office in Tempe AZ

Calcified Plaque Can Cause “Toothache”

Calcified plaque are unremoved food debris that become hardened and adhered onto the surface of a tooth.  Within the calcified plaque, millions of bacteria can grow which causes localized inflammation to the gingival tissue around the tooth.  Also, the gingival pockets will enlarge and external stimulants such as cold water, sour beverages, etc can penetrate to the root surface of the tooth and causes “toothache.”  The root surface of the tooth is usually more prone to sensitivity because it does not have the outer enamel layer as the coronal portion of the tooth does.  So whenever there is stimulant reaching the root, the tooth is more susceptible to the stimulation.

The cure to this problem is to mechanically remove the calcified plaque within the sulcus of the tooth.  This can be done by a regular cleaning procedure if the person does not have periodontal disease.  However, if there is periodontal disease, then periodontal treatment such as scaling and root planing procedure, would be necessary.  Also, rinsing with medicated mouth rinse can help decrease the bacteria level and this decreases the inflammation.


Written by Daniel Tee, DDS, MS

Dental Office in Tempe AZ

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.


Periodontal Cleaning

Periodontal cleaning is a broad category of dental treatments for removing the disease-causing bacteria and toxins in the periodontium in a person’s mouth.  Periodontium consists of supporting tissue, bone structure and ligaments around the teeth.  Brushing and flossing might not be adequate in completely removing the bacteria and toxins in the periodontium.  Dentist would evaluate the severity of periodontal problems and then determine treatment for the patient.

The most basic periodontal treatment is basic dental cleaning.  Patient would have basically good oral hygiene with only minimal plaque within the shallow gum pockets.

However, if the patient shows early to moderate gum pockets, some bone loss, bleeding or more than one of these symptoms, the dentist would perform a procedure called Scaling And Root Planing.  Dentist would have to remove all calculus from the deep gum pockets and cleanse off all toxins with medicated rinse.  Dentist would typically treat one half of the periodontium and would complete both sides in two visits.  Dentist would anesthetize the treatment region for patient’s comfort.

If the patient shows more severe periodontal problems, dentist would need to perform periodontal surgery.  Dentist would perform surgery on the gum tissue so to expose the deepest crevice in the gum pockets in order to facilitate complete removal of toughest calculus and toxins.


Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Osteoporosis Causes Loose Teeth

Osteoporosis is a common skeletal disease which causes the weakening of the bone structure and as a result, the bone fracture occurs.  The disease can exist in the jaw joint and jaw bone.  It causes periodontal problem and eventually it may contribute to loosening of teeth and ultimately, tooth lost.

Woman may have more periodontal problem than men.  Especially after menopause, the changes in female hormone may cause osteoporosis and this affects the condition of their teeth and bone support around them.

In elderly age, osteoporosis may cause damage to the bone support of teeth.  Even if they are edentulous (or lack of any teeth), osteoporosis can cause the loosening of their denture because the denture relies on the ridge bone for support.  If the bone within the ridge are weakened, the denture may not have adequate support and become destabilized.

Dentist can help diagnosis and treat periodontal disease, decreasing the detrimental effect of osteoporosis.


Written by Daniel Tee, DDS, MS

Practicing Tempe Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Periodontal Probing

Periodontal probing is the measurement of the gum pockets for evaluating the periodontal disease status.  It is done with a periodontal probe which is a instrument with depth marking and it is inserted into the gum pocket to measure its depth.  The depth of the gum pocket corresponds to the loss of attachment of the gum tissue to the surface of tooth.  It indicates the periodontal disease status.


The loss of attachment occurs when there is inflammation of the gum tissue.  When there is a bone loss around a tooth, the periodontal probing can also indicate the amount of bone loss.  The amount of bone loss can also be confirmed by the bitewing radiographs.

For new patient who comes in for comprehensive exam, I would establish a baseline periodontal probing measurement and record those measurements in patient’s chart.  Each tooth is probed at six different site.  Three on the facial side of the tooth; another three on the lingual side of the tooth.  The recorded gum pocket depths are written on the periodontal chart.  The following is a periodontal chart:

Periodontal disease, gum treatment

Periodontal disease, gum treatment


The patient has only one missing teeth.  The teeth are numbered from 1 to 32.   There are three dates on the chart.  The initial baseline measurements show probing depth ranging from 1 to 5 mm.  Depth from 1 to 3mm is considered normal depth for typically healthy gum tissue.  Depth from 4 to 5 mm indicates some incipient periodontal problem.  From the initial measurements, it shows that the patient used to have incipient stage of periodontal disease.  Thus I perform the periodontal treatment called Scaling and Root Planing.


Then patient would come in for periodontal maintenace once every 3 months.  Subsequent visits I re-measure the gum pockets and the patient shows significant improvement in the health of gum tissue.  There are reduction of pocket depths.  In the most recent visit, patient has almost all of his teeth return to normal range.


Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Kidney Transplant and Periodontitis

I remembered some time ago I had a patient whose physician asked me to treat his periodontitis prior to his kidney transplantation.  His physician thought the patient had periodontitis.  This is a new trend that the patient had to be screen for various localized infection/disease prior to kidney transplantation and one of the localized infection that requires treatment is the dental periodontitis. (reference source)

The bacteria within the mouth can cause infection.  The presence of periodontitis can cause the increase of bacterial growth.  For the patient who has kidney disease, his/her immune system might be weak and can get infection easily.

For kidney transplantation, the medical surgeon would require patient to have dental checkup and treatment, and this includes the treatment for periodontitis.  The reasons for dental treatment is that after the kidney transplant, the patient would be administered with drugs to prevent rejection of the newly transplanted kidney by the body’s immune system.  These are immune-suppression drugs.  And these drugs would decrease immune system response to bacterial attack.  The patient would be more susceptible to bacterial infection during the immunal therapy after the transplantation.  Thus, the doctor would have to make sure that the patient has no existing bodily infection.  The dentist is asked to check for any dental infection and one of the common dental infections is periodontitis.  With patient’ dental periodontitis under active control, this lowers the likelihood of bodily infection from the dental cause.


Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Medicated Mouth Rinse in Periodontal Treatment

Medicated mouth rinse is often used to treat the root surfaces of the teeth after the dentist has thoroughly performed the periodontal treatment on those teeth.  The purpose is to decrease the bacteria load in the periodontal pockets so that the normal healing process can occur to repair the diseased gum tissue.  Peridex rinse is one kind of the medicated mouth rinse.  It contains active ingredient chlorhexidine which is shown in clinical research that it is effective in killing the specific types of bacteria causing the periodontal disease and if used correctly, it can adhere to the root surface of the tooth so to prolong the effective anti-microbial action time.

The diseased gum tissue would be inflammed and swollen.  The diseased gum tissue would detach itself from the tooth and as the result the gum pocket would deepen.  The inflammation is caused by the bacteria growth around the root surface of the tooth and the gum pocket area.  The non-surgical periodontal treatment would be to remove the plaque and calculus which is full of those bacteria.  After removal of those plaque and calculus, the remaining bacteria is to be killed off by the medical mouth rinse.  This is to maximize the healing potential of the gum tissue.   Once the disease-causing bacteria is gone, the gum tissue can repaired itself and it will become more strengthened and reattach itself to the root surface of the tooth.

Pregnancy Gingivitis

Pregnancy gingivitis is the gingivitis happen during pregnancy.  During pregnancy, a woman’s body undergoes numerous changes, especially changes in the hormone balance in the body.  The hormonal changes would cause the gingivitis via two primary routes.

The hormonal changes causes the increased blood flow to the gum tissue, making it more irritable, more sensitive and more swollen.  Secondly, the hormonal changes decrease the body’s normal immune response to bacteria.  So when there is plaque, the bacteria in the gum tissue would be more likely to grow and causes the infection to the gum.  This is called the pregnancy gingivitis.

Thus, good oral hygiene is generally recommended during pregnancy.  Routine dental checkup and cleaning would help minimize the effect of gingivitis.  However, if the gingivitis is left untreated, it may progress into a more severe form called the periodontitis.  The periodontitis is a periodontal disease characterized by increased bone loss, gingival infection and inflammation and tooth mobility.

Usually after child birth, the condition of the gum would return back to normal.  Bleeding and swelling should subside.   However, if the symptoms continue, please contact your dentist for checkup.


Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Bleeding Gum and Diabetes

Sometimes when we brush our teeth, we notice our gum bleeds.  Often we would perceive this as a small problem and we would ignore it.  We think that it will eventually go away.

However, bleeding gum can be a warning sign.  The gum bleeds because there could be some infection within the gum.  And these infection is called periodontitis.  Periodontitis can be caused by poor immune system, lack of proper oral hygiene, pregnancy and uncontrolled diabetes.

Proper oral hygiene can decrease the effect of periodontitis. Proper oral health can also improve the oversall systemic health.  For example, recent research studies indicate that there is a relationship between diabetes and perioddontitis.  Controlling the diabetes can help controlling the disease progress of periodontitis.  And vice versa: keep the mouth and gum healthy can help decrease the disease progress of diabetes.  As a family dentist, I have the priviledge of seeing patient in regular routine checkup intervals and be able to monitor their dental and periodontal status of my patients.

If the periodontitis is left untreated, it can progress to toothache, tooth looseng and tooth loss.  Overall health can be affected also because untreated periodontitis can affect the diabetes and the heart.


Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.